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P45 Neonatal outcome in late-preterm hypertensive pregnancies – is there an optimal timing for delivery?
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Poster Presentations / Pregnancy Hypertension 1, Supplement 1 (2010) S43–S76
channels that can be modulated by KCNE1-5 encoded accessory proteins. These channels are known to play a role in the reactivity of other blood vessels. We have previously shown that KCNQ1/4 and KCNE1/3/5 were the most abundant isoforms in normotensive control (NC) placentae. The aim of this study was to determine whether these genes were differentially expressed in women with PE (delivering at term [≥37 weeks’]: n=13; or delivering preterm [<37 weeks’]: n=8) compared to NC (n=26), and to assess protein expression/localisation of the most abundant isoforms. Methods: Placental biopsies were taken midway between the cord and periphery from NC and PE Caucasian women following informed written consent. KCNQ/KCNE mRNA expression was measured by qRT-PCR and normalised to stably expressed GAPDH. Immunohistochemistry was used to measure protein expression. Results: KCNE5 was significantly upregulated in PE (median [IQR]: 1.942[0.905, 3.379]) vs. NC (0.159[0.088, 0.288]; P=0.001). Conversely, KCNE1 expression was reduced in PE (0.008[0.004, 0.027]; P ≤0.05). Further analysis revealed that KCNQ1, KCNQ4 and KCNE1 isoforms were downregulated in term vs. preterm PE P ≤0.05). Interestingly, KCNE1 expression was reduced in term, but not preterm PE, vs. NC. Initial results revealed relatively low expression of KCNQ4 and KCNE1 encoded proteins, localised mainly in stromal areas. Conclusion: Kv7 channels are expressed in placenta. Modulation of all isoforms studied in PE, with the exception of KCNE3, suggests they may play a functional role. Differential expression of isoforms may lead to altered cell proliferation and/or vascular reactivity. Ongoing studies will determine complete mRNA/protein expression profiles in NC and PE placentae and investigate whether Kv7 channels are affected differently in other regions of the placenta. Funding: Action Medical Research, Rosetrees Trust & Tommy’s Charity.
P44 Neonatal outcome following delivery at 34-36 weeks’ gestation in hypertensive pregnancies Genevieve P.G. Fung 1 , Wilfred C.W. Leung 1 , Monica L.M. Chan 1 , Y.C. Ho 1 , Bill H.B. Chan 1 , Terence T.H. Lao 2 . 1 Department of Paediatrics, United Christian Hospital, Hong Kong; 2 Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong Background and objectives: Maternal pre-eclampsia (PET) and pregnancyinduced hypertension (PIH) is associated with preterm delivery. While late-preterm birth at 34-36 weeks’ gestation is generally considered acceptable with respect to problems with prematurity, there is paucity of data on the neonatal outcome of infants from hypertensive pregnancies delivered at 34-36 weeks compared with infants delivered after 37 weeks. This retrospective review was conducted to address this issue. Method: All live-births from hypertensive pregnancies delivered at 34-36 weeks’ gestation at a tertiary referral centre from 1 January 2008 to 31 December 2009 were reviewed. Infants with major congenital anomalies were excluded. Neonatal complications and outcome are compared between late-preterm infants and term infants delivered from pregnancies associated with PET/PIH. Results: A total of 63 late-preterm infants and 262 term infants were included in the study. Results are shown in the table below: Table 1. Perinatal outcome in hypertensive pregnancies – comparison between latepreterm (n=63) and term (n=262) live-born infants (Results expressed in %)
Small for gestation (SGA) Admission NICU Hypothermia Hypoglycaemia Polycythaemia Clinical sepsis Sepsis Neonatal jaundice requiring phototherapy Feeding problem Transient tachypnoea of newborn (TTN) Respiratory distress syndrome (RDS)
34-36 weeks
≥37 weeks
P value
OR (95% CI)
41.3 15.9 6.3 44.4 14.3 3.2 4.8
6.1 2.3 1.9 10.3 6.5 8.8 0
<0.001 <0.001 0.041 NS <0.001
10.8 (5.3-22.0) 8.05 (2.81-23.1) 3.49 (0.91-13.4) 6.96 (3.68-13.2) 2.40 (1.02-5.68) – –
23.8 3.2
17.9 6.1
NS NS
– –
17.5
8.0
0.024
2.43 (1.10-5.34)
1.6
0
0.041
–
0.054
<0.001
Conclusion: Compared to term infants, late-preterm infants from hypertensive pregnancies are associated with a significantly higher incidence of SGA, NICU admission, hypoglycaemia, polycythaemia, sepsis, TTN and RDS. This should be taken into consideration in the counseling and decision
for delivery in women with hypertensive pregnancies presenting at 34-36 weeks gestation.
P45 Neonatal outcome in late-preterm hypertensive pregnancies – is there an optimal timing for delivery? Genevieve P.G. Fung 1 , Wilfred C.W. Leung 1 , Monica L.M. Chan 1 , Y.C. Ho 1 , H.B. Chan 1 , Terence T.H. Lao 2 . 1 Department of Paediatrics, United Christian Hospital, Hong Kong; 2 Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong Background and objectives: Maternal pre-eclampsia and pregnancyinduced hypertension are associated with preterm delivery. Recent reports have challenged the traditional belief that late-preterm deliveries at 34-36 weeks are low-risk without significantly increased incidence of neonatal complications. There is little data on the optimal timing for delivery in the late-preterm period to optimise the neonatal outcome in hypertensive pregnancies. This retrospective study aims to address this question. Method: All live-births from hypertensive pregnancies delivered at 34-36 weeks’ gestation at a tertiary referral centre from 1 January 2008 to 31 December 2009 were reviewed. Infants were grouped according to gestational age in weeks for comparision of neonatal complications with term infants from hypertensive pregnancies. Results: The neonatal complications with respect to gestation at delivery are shown in the table below: 34 weeks 35 weeks 36 weeks ≥37 weeks Number of infants Small for gestation (SGA)1,a NICU admission1,a Hypothermia2,b Hypoglycaemia1,a Polycythaemia1,c Clinical sepsis Sepsis1 Jaundice Treatment Feeding problem Transient tachypnoea of newborn (TTN)3,d
10 60.0 40.0 20.0 20.0 10.0 0 0 30.0 10.0 30.0
15 33.3 0 6.7 66.7 40.0 0 0 26.7 0 6.7
38 39.5 15.8 2.8 42.1 5.3 5.3 7.9 21.1 2.6 18.4
262 6.1 2.3 1.9 10.3 6.5 8.8 0 17.9 6.1 8.0
Chi-square test, 1 p<0.001, 2 p=0.006, 3 p=0.031. Spearman’s correlation, a p<0.001, b p=0.028, c p=0.021, d p=0.024.
Conclusions: Our results indicated that there was increased risk of neonatal morbidity in late-preterm infants up to 36 weeks gestation compared with term infants. Furthermore, correlation between incidence of complications with gestational age was present but poor and without any apparent “optimal” timing for delivery in the late-preterm period. Therefore the consideration for delivery should be based more in maternal and fetal condition than on gestational age per se.
P46 Podocyturia may reflect ongoing glomerular disturbance in preeclampsia Nelson Sass, Thaís Facca, Jussara L. Sato, Leandro G. Oliveira, Amélia R. Pereira, Vicente P.C. Teixeira, Gianna M. Kirsztajn. Federal University of São Paulo, São Paulo, Brazil Background: Several studies have shown the existence of podocyte damage in proteinuric glomerular diseases (PG) and preeclampsia (PE). The podocyturia may be related to urinary protein loss as a result of the disruption of the glomerular filtration barrier. It may also lead to an impaired glomerular function because of its limited regenerative capacity. PE is the main cause of glomerular disturbance and its renal alterations have an important clinical impact. Aims: To evaluate the podocyturia in healthy pregnancy (HP), PE and PG in women and other renal parameters such as serum creatinine level (CREA) and 24-hour proteinuria (24h-prot). Methods: HP (n=3), PE (n=4) and PG (n=4) had their urine samples cytocentrifugated onto two slides and they were observed under the microscope by indirect immunofluorescence using Wilms’ Tumor 1 rabbit anti-human IgG polyclonal antibody and goat anti-rabbit IgG FITC as secondary antibody. Serum creatinine level and 24-hour proteinuria were obtained from the PE and PG groups. Results: The mean age of HP, PE and PG groups was 28, 27 and 23 years respectively. The mean gestational age of the pregnant women was 33/34 weeks. The averages of CREA and 24h-prot were, respectively, 0.5mg/dl
Poster Presentations / Pregnancy Hypertension 1, Supplement 1 (2010) S43–S76
channels that can be modulated by KCNE1-5 encoded accessory proteins. These channels are known to play a role in the reactivity of other blood vessels. We have previously shown that KCNQ1/4 and KCNE1/3/5 were the most abundant isoforms in normotensive control (NC) placentae. The aim of this study was to determine whether these genes were differentially expressed in women with PE (delivering at term [≥37 weeks’]: n=13; or delivering preterm [<37 weeks’]: n=8) compared to NC (n=26), and to assess protein expression/localisation of the most abundant isoforms. Methods: Placental biopsies were taken midway between the cord and periphery from NC and PE Caucasian women following informed written consent. KCNQ/KCNE mRNA expression was measured by qRT-PCR and normalised to stably expressed GAPDH. Immunohistochemistry was used to measure protein expression. Results: KCNE5 was significantly upregulated in PE (median [IQR]: 1.942[0.905, 3.379]) vs. NC (0.159[0.088, 0.288]; P=0.001). Conversely, KCNE1 expression was reduced in PE (0.008[0.004, 0.027]; P ≤0.05). Further analysis revealed that KCNQ1, KCNQ4 and KCNE1 isoforms were downregulated in term vs. preterm PE P ≤0.05). Interestingly, KCNE1 expression was reduced in term, but not preterm PE, vs. NC. Initial results revealed relatively low expression of KCNQ4 and KCNE1 encoded proteins, localised mainly in stromal areas. Conclusion: Kv7 channels are expressed in placenta. Modulation of all isoforms studied in PE, with the exception of KCNE3, suggests they may play a functional role. Differential expression of isoforms may lead to altered cell proliferation and/or vascular reactivity. Ongoing studies will determine complete mRNA/protein expression profiles in NC and PE placentae and investigate whether Kv7 channels are affected differently in other regions of the placenta. Funding: Action Medical Research, Rosetrees Trust & Tommy’s Charity.
P44 Neonatal outcome following delivery at 34-36 weeks’ gestation in hypertensive pregnancies Genevieve P.G. Fung 1 , Wilfred C.W. Leung 1 , Monica L.M. Chan 1 , Y.C. Ho 1 , Bill H.B. Chan 1 , Terence T.H. Lao 2 . 1 Department of Paediatrics, United Christian Hospital, Hong Kong; 2 Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong Background and objectives: Maternal pre-eclampsia (PET) and pregnancyinduced hypertension (PIH) is associated with preterm delivery. While late-preterm birth at 34-36 weeks’ gestation is generally considered acceptable with respect to problems with prematurity, there is paucity of data on the neonatal outcome of infants from hypertensive pregnancies delivered at 34-36 weeks compared with infants delivered after 37 weeks. This retrospective review was conducted to address this issue. Method: All live-births from hypertensive pregnancies delivered at 34-36 weeks’ gestation at a tertiary referral centre from 1 January 2008 to 31 December 2009 were reviewed. Infants with major congenital anomalies were excluded. Neonatal complications and outcome are compared between late-preterm infants and term infants delivered from pregnancies associated with PET/PIH. Results: A total of 63 late-preterm infants and 262 term infants were included in the study. Results are shown in the table below: Table 1. Perinatal outcome in hypertensive pregnancies – comparison between latepreterm (n=63) and term (n=262) live-born infants (Results expressed in %)
Small for gestation (SGA) Admission NICU Hypothermia Hypoglycaemia Polycythaemia Clinical sepsis Sepsis Neonatal jaundice requiring phototherapy Feeding problem Transient tachypnoea of newborn (TTN) Respiratory distress syndrome (RDS)
34-36 weeks
≥37 weeks
P value
OR (95% CI)
41.3 15.9 6.3 44.4 14.3 3.2 4.8
6.1 2.3 1.9 10.3 6.5 8.8 0
<0.001 <0.001 0.041 NS <0.001
10.8 (5.3-22.0) 8.05 (2.81-23.1) 3.49 (0.91-13.4) 6.96 (3.68-13.2) 2.40 (1.02-5.68) – –
23.8 3.2
17.9 6.1
NS NS
– –
17.5
8.0
0.024
2.43 (1.10-5.34)
1.6
0
0.041
–
0.054
<0.001
Conclusion: Compared to term infants, late-preterm infants from hypertensive pregnancies are associated with a significantly higher incidence of SGA, NICU admission, hypoglycaemia, polycythaemia, sepsis, TTN and RDS. This should be taken into consideration in the counseling and decision
for delivery in women with hypertensive pregnancies presenting at 34-36 weeks gestation.
P45 Neonatal outcome in late-preterm hypertensive pregnancies – is there an optimal timing for delivery? Genevieve P.G. Fung 1 , Wilfred C.W. Leung 1 , Monica L.M. Chan 1 , Y.C. Ho 1 , H.B. Chan 1 , Terence T.H. Lao 2 . 1 Department of Paediatrics, United Christian Hospital, Hong Kong; 2 Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong Background and objectives: Maternal pre-eclampsia and pregnancyinduced hypertension are associated with preterm delivery. Recent reports have challenged the traditional belief that late-preterm deliveries at 34-36 weeks are low-risk without significantly increased incidence of neonatal complications. There is little data on the optimal timing for delivery in the late-preterm period to optimise the neonatal outcome in hypertensive pregnancies. This retrospective study aims to address this question. Method: All live-births from hypertensive pregnancies delivered at 34-36 weeks’ gestation at a tertiary referral centre from 1 January 2008 to 31 December 2009 were reviewed. Infants were grouped according to gestational age in weeks for comparision of neonatal complications with term infants from hypertensive pregnancies. Results: The neonatal complications with respect to gestation at delivery are shown in the table below: 34 weeks 35 weeks 36 weeks ≥37 weeks Number of infants Small for gestation (SGA)1,a NICU admission1,a Hypothermia2,b Hypoglycaemia1,a Polycythaemia1,c Clinical sepsis Sepsis1 Jaundice Treatment Feeding problem Transient tachypnoea of newborn (TTN)3,d
10 60.0 40.0 20.0 20.0 10.0 0 0 30.0 10.0 30.0
15 33.3 0 6.7 66.7 40.0 0 0 26.7 0 6.7
38 39.5 15.8 2.8 42.1 5.3 5.3 7.9 21.1 2.6 18.4
262 6.1 2.3 1.9 10.3 6.5 8.8 0 17.9 6.1 8.0
Chi-square test, 1 p<0.001, 2 p=0.006, 3 p=0.031. Spearman’s correlation, a p<0.001, b p=0.028, c p=0.021, d p=0.024.
Conclusions: Our results indicated that there was increased risk of neonatal morbidity in late-preterm infants up to 36 weeks gestation compared with term infants. Furthermore, correlation between incidence of complications with gestational age was present but poor and without any apparent “optimal” timing for delivery in the late-preterm period. Therefore the consideration for delivery should be based more in maternal and fetal condition than on gestational age per se.
P46 Podocyturia may reflect ongoing glomerular disturbance in preeclampsia Nelson Sass, Thaís Facca, Jussara L. Sato, Leandro G. Oliveira, Amélia R. Pereira, Vicente P.C. Teixeira, Gianna M. Kirsztajn. Federal University of São Paulo, São Paulo, Brazil Background: Several studies have shown the existence of podocyte damage in proteinuric glomerular diseases (PG) and preeclampsia (PE). The podocyturia may be related to urinary protein loss as a result of the disruption of the glomerular filtration barrier. It may also lead to an impaired glomerular function because of its limited regenerative capacity. PE is the main cause of glomerular disturbance and its renal alterations have an important clinical impact. Aims: To evaluate the podocyturia in healthy pregnancy (HP), PE and PG in women and other renal parameters such as serum creatinine level (CREA) and 24-hour proteinuria (24h-prot). Methods: HP (n=3), PE (n=4) and PG (n=4) had their urine samples cytocentrifugated onto two slides and they were observed under the microscope by indirect immunofluorescence using Wilms’ Tumor 1 rabbit anti-human IgG polyclonal antibody and goat anti-rabbit IgG FITC as secondary antibody. Serum creatinine level and 24-hour proteinuria were obtained from the PE and PG groups. Results: The mean age of HP, PE and PG groups was 28, 27 and 23 years respectively. The mean gestational age of the pregnant women was 33/34 weeks. The averages of CREA and 24h-prot were, respectively, 0.5mg/dl